Freiburg, Germany—According to recent trials, aspirin does not appear to have much benefit in primary prevention of cardiovascular disease, but a new study suggests taking aspirin could be doing some harm beyond increasing bleeding risk in some patients.

The report in ESC Heart Failure points out that the role of aspirin on the risk of incident heart failure (HF) has not been well understood. As a result, European researchers sought to evaluate the role of aspirin use on HF incidence in primary and secondary prevention and whether aspirin use increases the risk of incident HF in patients at risk.

The study team found that aspirin use is associated with a 26% elevated risk of HF in patients with at least one predisposing factor for the condition, including smoking, obesity, high blood pressure, high cholesterol, diabetes, and cardiovascular disease.

"This is the first study to report that among individuals with a least one risk factor for heart failure, those taking aspirin were more likely to subsequently develop the condition than those not using the medication," said lead author Blerim Mujaj, MD, PhD, of the University of Freiburg, Germany. "While the findings require confirmation, they do indicate that the potential link between aspirin and heart failure needs to be clarified."

The study team used data from 30,827 patients at risk for HF who were enrolled in six observational studies; 33.9% were women with a mean age of 66.8 years. With cardiovascular risk factors and aspirin use recorded at baseline, patients were followed up for the first incident of fatal or nonfatal HF.

During the analysis, researchers assessed the association of incident HF with aspirin use; this was evaluated using multivariable-adjusted proportional hazard regression, which accounted for study and cardiovascular risk factors. “Over 5.3 years (median; 5th to 95th percentile interval, 2.1 to 11.7 years), 1,330 patients experienced HF,” the authors write. “The fully adjusted hazard ratio (HR) associated with aspirin use was 1.26 [95% confidence interval (CI) 1.12–1.41; P ≤ 0.001]. Further, in a propensity-scorematched analysis, the HR was 1.26 (95% CI 1.10–1.44; P ≤ 0.001). In 22,690 patients (73.6%) without history of cardiovascular disease, the HR was 1.27 (95% CI 1.10–1.46; P = 0.001).”

Calling the influence of aspirin on HF "controversial," the researchers conclude, "In patients, at risk, aspirin use was associated with incident HF, independent of other risk factors. In the absence of conclusive trial evidence, our observations suggest that aspirins should be prescribed with caution in patients at risk of HF or having HF."

"This was the first large study to investigate the relationship between aspirin use and incident heart failure in individuals with and without heart disease and at least one risk factor," Dr. Mujaj advised. "Aspirin is commonly used—in our study, one in four participants were taking the medication. In this population, aspirin use was associated with incident heart failure, independent of other risk factors."

He called for large, multinational randomized trials in adults at risk for HF, adding, "Until then, our observations suggest that aspirin should be prescribed with caution in those with heart failure or with risk factors for the condition."

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